Organization
INITIA NOVA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK O SULLIVAN D.O. (CHIEF MEDICAL OFFICER)
(856) 625-8563
Entity
Organization
Contact information
Practice address
1930 MARLTON PIKE E STE H42, CHERRY HILL, NJ 08003-4104
(856) 425-2942
Mailing address
1930 MARLTON PIKE E STE H42, CHERRY HILL, NJ 08003-4104
(856) 425-2942
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NJ
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
37F100176500
NJ
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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